{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:02:05Z","timestamp":1784869325133,"version":"3.55.0"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>\n                    Severe rheumatic mitral stenosis (MS) is one of the highest-risk valvular lesions in pregnancy, and it becomes particularly hard to manage when the valve is unsuitable for percutaneous balloon mitral valvuloplasty (PBMV) and the patient declines termination. We describe a 20-year-old primigravida who presented at 23.5 weeks of gestation with progressive dyspnea, having deteriorated from New York Heart Association (NYHA) class I to class III. Multimodality echocardiography confirmed severe rheumatic MS, with a valve area of 0.5 cm\n                    <jats:sup>2<\/jats:sup>\n                    by two-dimensional planimetry and 0.572 cm\n                    <jats:sup>2<\/jats:sup>\n                    by three-dimensional transesophageal planimetry, a mean transmitral gradient of 15 mmHg, and a Wilkins score of 13, together with severe left atrial dilatation and pulmonary hypertension. PBMV was not feasible. After a shared decision-making process that respected the patient's refusal of termination, a multidisciplinary cardio-obstetric team provided a medical bridge aimed at fetal viability. Acute pulmonary edema at 28.1 weeks led to cesarean delivery of a 940\u2005g neonate, and the patient underwent uncomplicated mechanical mitral valve replacement two weeks postpartum. The case shows how shared decision-making, multidisciplinary care, and the timing of surgery after delivery can be combined to protect both mother and child.\n                  <\/jats:p>","DOI":"10.3389\/fcvm.2026.1918698","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:22:46Z","timestamp":1784866966000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Shared decision-making in severe rheumatic mitral stenosis complicating pregnancy"],"prefix":"10.3389","volume":"13","author":[{"given":"Luis Armando","family":"Vel\u00e1squez Trujillo","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Universidad del Valle","place":["Cali, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel Alejandro","family":"Hurtado Rivera","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Universidad del Valle","place":["Cali, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00edctor Rafael","family":"Bucheli Enr\u00edquez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Universidad del Valle","place":["Cali, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebasti\u00e1n","family":"Ayala Zapata","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Universidad del Valle","place":["Cali, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephany","family":"Barbosa Balaguera","sequence":"additional","affiliation":[{"name":"Cardiovascular Surgery Research Group, Department of Cardiology, Cl\u00ednica Sebasti\u00e1n de Belalc\u00e1zar (Cl\u00ednica Colsanitas S.A.)","place":["Cali, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1lvaro Andr\u00e9s","family":"Herrera Escand\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Universidad del Valle","place":["Cali, Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3165","DOI":"10.1093\/eurheartj\/ehy340","article-title":"2018 ESC guidelines for the management of cardiovascular diseases during pregnancy","volume":"39","author":"Regitz-Zagrosek","year":"2018","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"3848","DOI":"10.1093\/eurheartj\/ehz136","article-title":"Pregnancy outcomes in women with cardiovascular disease: evolving trends over 10 years in the ESC Registry Of Pregnancy And Cardiac disease (ROPAC)","volume":"40","author":"Roos-Hesselink","year":"2019","journal-title":"Eur Heart 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in pregnancy: a case report","volume":"5","author":"Eng-Frost","year":"2021","journal-title":"Eur Heart J Case Rep"},{"key":"B14","doi-asserted-by":"publisher","first-page":"ytae055","DOI":"10.1093\/ehjcr\/ytae055","article-title":"Case report of pregnancy complicated by severe pulmonary hypertension from mitral stenosis and placenta accreta spectrum disorder: management of two life-threatening conditions","volume":"8","author":"Batra","year":"2024","journal-title":"Eur Heart J Case Rep"}],"container-title":["Frontiers in Cardiovascular 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